tbuckley/cabot-search huggingface dataset:
Germline thrombophilia gene alterations and thrombosis rates among patients with advanced germ cell tumors treated with chemotherapy.
Authors: Landon Carter Brown, Myra M. Robinson, Michael Joseph McCormack, Nury Steuerwald, James Thomas Symanowski, Rupali Bose, Brittany Neelands, Tobi Akinyelu, Chad Livasy, Wencheng Li, Nathanael C. Haynes, Claud Grigg, Derek Raghavan, Peter E Clark, Jai Narendra Patel, Earle F Burgess
Journal: Journal of Clinical Oncology (2023)

e17023 Background: Men with advanced germ cell tumors (GCT) treated with cisplatin-based chemotherapy are at high risk of venous thromboembolism (VTE). Validated predictors of VTE would allow development of targeted prophylactic anticoagulation strategies in this population. We hypothesized that a high genomic risk score from a previously identified panel of germline single nucleotide polymorphisms (SNPs) in thrombophilia genes would be associated with an increased risk of VTE within 6 months of chemotherapy initiation for GCT. Methods: Men with stage IIA or higher GCT who received 3-4 cycles of cisplatin-based chemotherapy were identified at two centers with available tissue for germline sequencing. High genomic risk was defined as having 4 or more risk alleles from an established 5 SNP germline panel composed of ABO (rs8176719), F5 (rs6025), F2 (rs1799963), FGG (rs2066865), and F11 (rs2036914). Univariable and multivariable logistic regression were used to evaluate the impact of genomic risk on VTE incidence within six months of chemotherapy initiation. Results: 123 patients were identified with 72% having non-seminoma histology and 28% categorized as IGCCCG intermediate or poor risk. The VTE rate was 26% (32/123), and the incidence of high genomic risk was 21% (26/123). Men with high genomic risk did not have a significantly higher VTE rate (31%, 8/26) than men with low genomic risk (25%, 24/97), unadjusted OR 1.4 (95% CI 0.5 – 3.5, p = 0.54). A multivariable model identified Khorana score, N3 status and elevated LDH as predictors for VTE (Table). The association between high genomic risk and VTE strengthened when adjusting for clinical variables, but remained non-significant, adjusted OR 2.1 (95% CI 0.7 – 6.5, p = 0.18). The optimal threshold to define high genomic risk in this cohort was 3 or more risk alleles, adjusted OR 2.5 (95% CI 0.9 – 6.8, p = 0.08). ABO (non-O blood type) was the only individual SNP significantly associated with VTE (p &lt; 0.01). Conclusions: In this multi-institutional cohort, a previously established germline thrombophilia panel was not clearly associated with increased VTE risk among patients with GCT receiving chemotherapy. Khorana score, elevated LDH, clinical nodal stage, and non-O blood type were the strongest predictors of VTE. Exploratory analysis of the association between VTE risk and 76 additional SNPs is ongoing. Prospective studies of prophylactic anticoagulation are warranted in high-risk patients with advanced GCT undergoing chemotherapy.[Table: see text]
Concurrent EGFR wild-type tongue squamous cell carcinoma and EGFR-mutant lung adenocarcinoma and response to osimertinib.
Authors: Fang Wu, Chunhong Hu, Sujuan Zhang, Shuxing Wang, Yue Pan, Fengjiao He, Can Lu, Yucheng Fu, Yue Zeng, Junqi Liu, Shenghao Shi, Yurong Peng, Chaoyue Xiao
Journal: Journal of Clinical Oncology (2023)

e18074 Background: Epidermal growth factor receptor (EGFR) mutation is most commonly oncogenic driver in lung adenocarcinoma with 50% incidence in Asians.Osimertinib is the third-generation epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI), which has been widely used in metastatic EGFR-mutant non-small cell lung cancer (NSCLC) and has significantly improved outcomes. At present, the treatment of HNSCC mainly relies on surgery or chemoradiotherapy. EGFR is overexpressed in more than 90% of head and neck squamous cell carcinoma (HNSCC). Targeted therapy for HNSCC is mainly monoclonal antibodies, while the application of small molecule inhibitors is limited. The EGFR-TKI can only be applied in subsequent-line, when disease progression on or after platinum therapy. However, the efficacy of EGFR-TKI in patients with both NSCLC and HNSCC remains unclear. Methods: We searched all patients with EGFR-mutation metastatic non-small cell lung cancer and HNSCC who used EGFR-TKI in the Second Xiangya Hospital. Tumor sections were assessed immunohistochemically using PD-L1 and EGFR expression. EGFR amplification was detected by fluorescence in situ hybridization (FISH). We collected clinical characteristics and treatment histories for all patients including time to progression on EGFR-TKI. Time to progression on EGFR-TKI was defined as time from start of EGFR-TKI to time of radiographic RECIST progression. The efficacy and prognosis were evaluated based on the RECIST (version 1.1). Results: We found an advanced lung adenocarcinoma patient who harbored an EGFR-mutation and concurrently had tongue squamous cell carcinoma with EGFR wild-type.The tongue tumor tissue sample for EGFR expression was positive by immunohistochemistry and EGFR amplification was negative by FISH. NGS showed inactive mutation of patched1 (PTCH1) and EGFR wild-type.PET-CT scans demonstrated a partial response (PR) of the lung tumor and tongue cancer after two months of treatment of osimertinib. The lung tumor maintian partial response until now (nearly 30 months). And the tongue tumor reached the first progression- free survival (PFS) at 21 months. Conclusions: The patient with NSCLC and tongue cancer who exhibited objective response to EGFR-TKI, osimertinib monotherapy. The result indicates a clear response of tongue cancer to osimertinib and the potential for the use of osimertinib in tongue cancer. However, with the specific mechanism largely unknown, it is necessary to study further the effect of osimertinib on HNSCC.
PSMAddition: A phase 3 trial to compare treatment with <sup>177</sup>Lu-PSMA-617 plus standard of care (SoC) and SoC alone in patients with metastatic hormone-sensitive prostate cancer.
Authors: Scott T. Tagawa, A. Oliver Sartor, Fred Saad, Alison Helen Reid, Olga V. Sakharova, Felix Y Feng, Karim Fizazi, Michael J. Morris
Journal: Journal of Clinical Oncology (2023)

TPS5116 Background: Lutetium ( 177 Lu) vipivotide tetraxetan ( 177 Lu-PSMA-617) plus protocol-permitted standard of care (SoC) significantly improved radiographic progression-free survival (rPFS) and overall survival (OS) in patients with prostate-specific membrane antigen (PSMA)-positive metastatic castration-resistant prostate cancer, previously treated with at least one androgen receptor pathway inhibitor (ARPI) and one or two taxanes. Androgen deprivation therapy (ADT) and ARPIs may alter PSMA expression and radiosensitivity. PSMAddition will assess the efficacy and safety of 177 Lu-PSMA-617 plus SoC versus SoC alone in adults with metastatic hormone-sensitive prostate cancer (mHSPC). Methods: PSMAddition (NCT04720157) is an international, prospective, open-label, randomized, phase 3 trial, with crossover, in adults with mHSPC. Eligible patients are treatment-naive or minimally treated candidates for hormonal therapy, with PSMA-positive disease (determined by 68 Ga-PSMA-11 PET/CT), ECOG performance status of 0 to 2 and adequate major organ function. Patients are excluded if they have rapidly progressing tumors that require chemotherapy. Approximately 1126 patients will be randomized 1:1 to receive 177 Lu-PSMA-617 (7.4 GBq every 6 weeks for a maximum of 6 cycles) plus SoC or SoC alone (an ARPI and ADT). Stratification factors are tumor volume (high/low), age (≥ 70/ &lt; 70 years), and previous/planned prostatectomy or radiation treatment of the primary prostate tumor (yes/no). Recruitment for a China extension cohort (40–60 patients) will follow after completion of main study recruitment. The primary endpoint is rPFS, as assessed by blinded independent centralized review. Upon centrally confirmed radiographic progression, participants in the SoC-only arm can cross over to the 177 Lu-PSMA-617 arm. The planned sample size provides 95% power to detect a hazard ratio of 0.7 for rPFS after 418 events with an overall one-sided significance level of 0.025. The key secondary endpoint is OS, others include the proportion of patients with a prostate-specific antigen (PSA) decline of ≥ 90% from baseline, time to development of metastatic castration-resistant prostate cancer, composite PFS (radiographic, clinical or PSA progression), safety and tolerability, and health-related quality of life. Imaging and biospecimen (tissue and blood) collection is embedded for correlative analysis. Participants who have received 177 Lu-PSMA-617 will have the option to enroll in a separate long-term safety follow-up study. Updated from previous presentation at the 2021 European Society for Medical Oncology Congress, FPN 3035, with permission. Clinical trial information: NCT04720157 .
Induction immunochemotherapy conversion rate and survival outcomes versus chemotherapy in initially unresectable esophageal squamous cell carcinoma.
Authors: Shujie Huang, Sichao Wang, Zhen Gao, Ruijie Zeng, Wei Xu, Yong Tang, Jiming Tang, Xiaosong Ben, Dongkun Zhang, Liang Xie, HaiYu Zhou, Gang Chen, Junhui Fu, Feng-Ming Spring Kong, Guibin Qiao
Journal: Journal of Clinical Oncology (2023)

e16077 Background: Currently, no comparative study has been reported to elucidate whether the addition of immunotherapy in the induction setting could improve treatment efficacy and prolong the overall survival of initially-unresectable locally advanced esophageal squamous cell carcinoma (iuESCC). This study aimed to compare surgical conversion rate and short-term overall survival in induction chemotherapy (iC) and induction immunochemotherapy (iIC) for patients with iuESCC. Methods: In this multicenter retrospective cohort study, patients with the guideline-defined unresectable disease were included at four high-volume institutions. The primary endpoints were conversion surgical rate and overall survival (OS). Pathological complete response (pCR) was defined as the disappearance of tumor cells in the primary lesion site. Multivariate cox regression analysis was used to identify the independent significant prognostic factors associated with OS. The stabilized inverse probability of treatment weighting (IPTW) was applied to confirm the survival comparison between iIC and iC cohorts. Results: A total of 309 patients (150 in iIC and 159 in iC cohort) were included. A significantly higher conversion surgical rate was observed in iIC cohort (iIC vs. iC: 127/150, 84.7% vs. 79/159, 49.7%, P &lt; 0.001). In terms of pathological response, the rates of pCR were 22.0% and 5.1% in the iIC and the iC cohort, respectively (P = 0.001). A significant difference in OS was observed between iIC (not reached) and iC cohorts (median [95% CI]: 36.3 [27.2 – 45.5] months). The stabilized IPTW yielded similar results. Regimen (iIC vs. iC, HR 0.215, 95% CI: 0.102 - 0.454, P &lt; 0.001) and operation (Yes vs. No, HR 0.262, 95% CI: 0.161 - 0.427, P &lt; 0.001) were the significant prognostic factors for OS. Further, subgroup analysis revealed that significantly higher OS was seen in iIC cohort than that in the iC cohort (P = 0.003) in patients who had non-pCR disease. Conclusions: Immunochemotherapy plus conversion surgery in the induction setting had higher pathological response rate and better OS in iuESCC patients. Moreover, this combined modality also contributed to improving OS in patients with residual tumor burden. This study provided evidence for future randomized control trial designs.
Development of a postoperative nomogram to predict disease-specific mortality in gastric cancer: A competing risk analysis using variables the AJCC recommends be collected and registered.
Authors: Etsuro Bando, Xinge Ji, Michael W. Kattan, Yusuke Koseki, Kenichiro Furukawa, Keiichi Fujiya, Yutaka Tanizawa
Journal: Journal of Clinical Oncology (2023)

e16099 Background: The American Joint Committee on Cancer (AJCC) has increasingly recognized the need for individual risk prediction model for the era of tailored therapy. In several reports, gastric cancer postoperative nomograms for predicting overall or disease-specific survival have been described. The AJCC Precision Medicine Core introduced the attractiveness of disease-specific mortality (DSM) as an endpoint of risk model. This study aimed to develop the first pretreatment gastric cancer postoperative nomogram for predicting DSM that considers competing risks (CRs). Methods: The nomogram was developed using data of 2,501 patients with primary gastric cancer who are potential candidate for adjuvant chemotherapy based on NCCN guideline, and it was created with a multivariable Fine and Gray subdistribution proportional hazard regression model. Fifteen pathological or non-tumor-related variables (age, sex tumor location, tumor size, macroscopic type, histology, depth (pT), number of positive nodes (pN), number of negative nodes, location of positive nodes, lymphovascular invasion, lavage cytology (CY), tumor margin, serum CEA and serum CA19-9) were collected. They are recommended to collect and register by the AJCC. The model was validated internally using measures of discrimination (Harrell’s C-index), calibration and decision curve analysis. Results: In the development procedure, multivariable analysis for DSM selected 12 variables (age, tumor location, macroscopic type, histology, pT, pN, number of negative nodes, location of positive nodes, lymphovascular invasion, CY, tumor margin and serum CEA) for constructing the nomogram. The developed nomogram showed good discrimination, with a C-index of 0.802(0.786-0.817) that of the American Joint Committee on Cancer (AJCC) pathological stage was 0.714 (0.697-0.734). The calibration appeared to be accurate for the 5-year prediction. Compared with scenarios in which no prediction model was used for postoperative treatment decision making (i.e., assume all or assume none), the nomograms had a favorable net benefit across a wide range of decision threshold probabilities between 5-year DSM probabilities of approximately 5 and 95%. Conclusions: This new postoperative risk model accurately predicts DSM in gastric cancer and can be used for patient counseling in clinical practice.
Transformation of tissue-resident, very small embryonic-like stem cells (VSELs) into cancer stem cells (CSCs) and its role in cancer initiation via epigenetic changes.
Authors: Deepa Bhartiya, Pushpa Singh, Ankita Kaushik
Journal: Journal of Clinical Oncology (2023)

e15084 Background: CSCs are postulated to initiate cancer but still no consensus on their surface markers and origin. Pluripotent VSELs exist in adult tissues, express receptors for steroid and gonadotropin hormones and are possible ‘embryonic remnants’ that could initiate cancer. Methods: Neonatal exposure to diethylstilbestrol (DES) or estradiol (E2) resulted in tumor-like changes in uterus and testes of 100 days old mice. Various studies included histological changes, VSELs enumeration by flow cytometry, and a carefully selected panel of transcripts by qRT-PCR to delineate various cellular events. Mice neonatally exposed to endocrine disruption were administered XAR (a nano-formulation of resveratrol) or transplanted niche-providing mesenchymal stromal cells on D60 and studied later on D100 for reversal/prevention of cancer phenotype. Results: Both E2 and DES resulted in increased numbers of VSELs in testis (Ctrl:0.2%; E2:0.4%; DES:1.3%) and uterus (Ctrl:18.52%; E2:35.42%; DES:40.57%). An up-regulation of pluripotent transcripts ( Oct-4, Sox-2, Nanog) was detected. Oct4A (specific marker for pluripotent VSELs) was upregulated after both DES (testis &gt; 8 folds; uterus &gt; 15 folds) and E2 (testis &gt; 3 folds and uterus &gt; 10 folds) treatment. Excessive self-renewal of VSELs was associated with dysregulated expression of DNA methyltransferases (Dnmts). Dnmt1 was downregulated while Dnmt3a, Dnmt3b, and Dnmt3L were upregulated in the testis. In the uterus, Dnmts showed increased expression after both E2 and DES treatment. Marked reduction of 5mC suggested global hypomethylation and increased Igf2 and Dlk-1 suggested affected/loss of imprinting at IGF2/H19 and DLK-1/MEG3 loci. VSELs acquired CSCs phenotype with increased expression of CD166 and ALDH1. Genomic instability in CSCs was suggested by dysregulated mismatch repair axis (DNMT-1/NP95/PCNA) and repair enzymes ( Brca-1, Rad-51, Mlh-1). Reduced expression of Pten and p53 was associated with blocked differentiation. Both reversal strategies resulted in normalization of stem cells compartment, improved differentiation (spermatogenesis/adenogenesis), reduced CSC markers, and increased p53, Pten, Np95, Sirt-1 expression. Interestingly, XAR treatment resulted in downregulation of Igf2 and Dlk1. Stem cells niche was also improved as evident by increased expression of SOX9 in testis and CD90, VIMENTIN in endometrium. Conclusions: Only immortal VSELs can transmit developmental insults to adult cells. Altered epigenetic state of VSELs resulted in cancer initiation and it was possible to prevent/reverse cancer by normalizing epigenetic state of VSELs and their niche. Targeting CSCs and pushing them back into quiescent VSELs and facilitating their normal differentiation offers novel method to win the war against cancer.
A novel, AI-generated morphologic biomarker to predict prostate cancer recurrence in patients with intermediate risk of progression.
Authors: Sujit Nair, Hassan Muhammad, Parag Jain, Chensu Xie, Ina Pavlova, Rachel Brody, Wei Huang, Maria Nakadar, Xiangfu Zhang, Hirak S Basu, George Wilding, Dimple Chakravarty, Rajat Roy, Ashutosh K. Tewari
Journal: Journal of Clinical Oncology (2023)

e17097 Background: About half of the prostate cancer (PCa) patients within an intermediate-risk group return to the clinic with disease progression after the first line of therapy. While these patients can be stratified into Gleason Grades (GG) 3+4 and 4+3, studies indicate that high-risk patients can still be found in both groups. Using our AI platform, we have developed a morphometric biomarker by analyzing digitized H&amp;E slide images (WSIs), which can accurately predict early biochemical recurrence (within 36 months post-surgery) and the risk of metastatic disease more accurately than GG, TNM staging, and genomic tools. Methods: 125 intermediate-risk (n = 67, 3+4; n = 58, 4+3) samples were collected from the Icahn School of Medicine at Mount Sinai (ISSMS) to form a held-out test set. Seventy-eight patients within the test set had an associated genomic score. A series of deep learning models trained using data from ISMMS, the University of Wisconsin-Madison, and TCGA generated a high dimensional vector for each WSI to provide a numerical representation of observed morphologies, which is then converted into a single score to predict biochemical recurrence within 36 months (BCR) and rank risk of metastasis (MET). Area-under-the-receiver operating characteristic (AROC) was used to measure the accuracy of BCR, and the concordance index (CI) was used to measure the performance of MET. The high and low-risk groups' hazard ratios (HR) for patients within grades 3+4 and 4+3 show that our model can further stratify GG. Results: Our method was significantly better at predicting BCR (AROC: 0.801) and ranking MET (CI: 0.764) relative to GG, TNM, and genomic tool (Table 1). We further sub-stratified the patients into GG 3+4 and 4+3 and identified high-risk patients within each GG. Patients in GG 3+4 with high PATHOMIQ scores had a significantly higher risk of BCR (HR 3.3; 95% CI 1.44 – 7.56; p &lt; 0.005) compared to the low PATHOMIQ score patients. A similar trend was seen in the GG 4+3 group (HR 3.0; 95% CI 1.32 – 6.83; p &lt; 0.01). Conclusions: Our histopathology-based prognostic biomarker significantly improves over standard clinical markers in stratifying patients with intermediate-risk PCa for BCR and MET. Our method overcomes several limitations of genomic testing: We only need digitized WSIs. Our method is non-destructive and preserves the tissue for further interrogation. Moreover, our turn-around time is a few hours. Thus, the PATHOMIQ scoring method may strongly impact the management of intermediate-risk PCa patients and clinical trial patient selection for the successful development of new therapies for early-stage PCa. [Table: see text]
Updated analysis of real-world treatment outcomes of first-line axitinib plus pembrolizumab in patients with advanced renal cell carcinoma in the United States.
Authors: Yousef Zakharia, Anna Vlahiotis, Gordon Siu, Dharanija Rao, Rosemary Teresi, Anthony Eccleston
Journal: Journal of Clinical Oncology (2023)

e16553 Background: The combination of axitinib plus pembrolizumab (AXI+PEM) is a standard of care in the first-line (1L) treatment of patients with advanced clear cell renal cell carcinoma (ccRCC). Previous analyses described the demographic and clinical characteristics, as well as outcomes of patients receiving 1L AXI+PEM in a real-world setting. We report updated data with longer follow-up for this cohort. Methods: Electronic medical record data from the Flatiron Health, nationwide de-identified Database (280 cancer clinics across 800 sites in the US) were used to select patients with confirmed Stage IV/metastatic RCC and who initiated 1L AXI+PEM on or after 1/1/2018 to 7/31/2022. Analyses included best overall response to 1L therapy; real-world progression-free survival (rwPFS) and overall survival (rwOS) are reported as patients without a clinical event (rwPFS; progression/death; rwOS; death) at landmark time periods (3, 6, 9, 12, 18 and 24 months); denominators include censored patients. Other data are reported as medians (min, max) unless otherwise noted. Results: Three hundred and forty patients received 1L AXI+PEM, with an extended mean follow-up of 19.2 (0.1–41.6) months. Most patients were male (69.1%) and mean age of 64.1 (21.0–83.0) years. At diagnosis, 56.5% of patients had Stage IV RCC and 78.2% of patients had clear cell histology. IMDC Risk Score was favorable, intermediate, and poor in 24 (6.8%), 123 (34.4%), and 78 (22.1%) patients, respectively (unknown = 125 (36.8%)). At the time of analysis, 192 patients (56.5%) received only 1L therapy with AXI+PEM, while 148 patients (43.5%) received ≥1 subsequent line of treatment. Vascular endothelial growth factor receptor (VEGF-R) inhibitors were the most commonly used second-line (2L) treatment (109 patients, 73.6%), with cabozantinib being the most frequently used VEGF-R inhibitor (84 patients, 77.1%). Median rwPFS was 8.6 (CI: 7.2-9.7) months with 15.0% of patients achieving rwPFS at 2 years. Median rwOS was 29.4 (CI: 24.2-37.3) months with 38.5% of patients alive at 2 years. Best overall response rate to 1L was 54.1% (complete or partial response observed in 184/340 patients). 51.5% of patients required a dose hold, of which 58.3% required it due to an adverse event. Conclusions: This updated analysis supports the use of 1L AXI+PEM in patients with advanced RCC across all IMDC risk groups, providing further understanding of the clinical outcomes and treatment patterns of patients with advanced RCC in the US. [Table: see text]